Metrics for the UK’s VPAG: A work in progress

Just as for previous schemes, metrics are being used to track VPAG, the UK’s voluntary scheme that covers branded medicines pricing and access. The first VPAG metrics slide deck was discussed as part of the first operational review meeting held on VPAG in July. Leela Barham gives an overview.

Metrics under discussion

Metrics to use to track the 2024 VPAG have been subject to discussions, with reference made to two days where talks were held (17th July and 19th July) in the July VPAG operational review meeting minutes, published on 4th October.

Understandable perhaps, given the need to focus on agreeing on a deal during negotiations in 2023, but it is not ideal that there was no agreement on metrics reached before the VPAG began. Perhaps a lesson to take into the next negotiations in 2028, the year that the current scheme is due to end.

Need for alignment with scheme objectives.

The ABPI is reported to have said in the July operational meeting that they wanted metrics to have a defined link to the scheme objectives; it is surprising that this even needed to be said.

Whilst not explicit, it does appear that the Department of Health and Social Care (DHSC), which operates the VPAG, are also the ones who do the work to produce the metrics, presumably getting data from NICE and others, too.

NICE pointed out how it has several internal metrics and that consistency and avoiding duplication was important.

The ABPI’s blog on the first six months of VPAG has called for a complete set of metrics.

Current metrics

The current metrics include:

Price applications for new products/significant new indications and price applications for New Active Substances (NAS)
Number of NICE Technology Appraisals and Highly Specialised Technologies and the percentage that are positive and a breakdown of Single Technology Appraisals of NAS and non-NAS by recommendation
Speed of NICE appraisal for the first output and the final output for those appraisals where the referral was received on time and the company did not request a delay
Number of scheme members, including a breakdown by company size and share of the total market
Sales before and after payments made under VPAG and the statutory scheme and scheme payments, as well as exempt sales and sales of small and medium companies
Growth in scheme scales with a breakdown by VPAG, statutory scheme as well as parallel imports
Data on UK Pharmascan – a database of information on new medicines, indications, and formulations in the pipeline - including the number of companies registered on the portal and the total number of live records
Commercial framework updates that describe activity under the NHS England commercial medicines framework
Rate of technology appraisal incorporation, presumably into clinical guidelines, something that NICE consulted upon earlier in the year

The ABPI has explicitly linked to the current metrics that are hosted on a Kahootz website as part of their blog looking at progress with VPAG after the first six months. That’s because they say that they want scheme members and patients to see how the scheme is doing (have any patient groups looked?).

Highlights from Quarter 1 2024 VPAG metrics

Highlights for 2024 given in operational review meeting minutes included an increase in the number of new product launches in Quarter 1 of 2024 versus the year before and an increase in price applications for New Active Substances, too.

The metrics themselves also reveal that, in both Q1 and Q2, there were very few “complex” patient access schemes (PAS) in operation. There were eight in quarter one of 2024 with 225 “simple” PAS, and in quarter two, nine complex and 229 simple. That’s a strong message to the industry; simple is much more feasible. Complex is defined by NICE as including outcome-based dose caps, rebates, and upfront free stock. Simple discount schemes are either a fixed pricing agreement that is lower than the list price or a percentage discount from the price.

As for commercial access agreements – defined by NICE as an agreement between NHS England and the company covering commercial terms and mitigating identified uncertainties – there were 111 in operation in Quarter one of 2024, increasing to 124 in Quarter two. The vast majority of these sit outside of the Cancer Drugs Fund (CDF) and the Innovative Medicines Fund (IMF). That shows that commercial access agreements can operate outside of special routes for funding. But it also shows just how common they are: business as usual, really.

As an aside, the metrics data on PAS’s and CAAs don’t match NICE’s data; they list 496 examples of approved PAS or other commercial arrangements, perhaps the difference relates to the timing of those schemes. Consistency would be helpful, though, if only to provide clarity about the landscape.

Wider metrics?

The link between the metrics on VPAG from the DHSC and the work of the Strategic Metrics Group, name-checked in the VPAG agreement, is not clear.

The Strategic Metrics Group is referenced in relation to tracking and assessing the update of new medicines by licensed indication where possible in the scheme document. References are also made to the Innovation Scorecard and Estimates Report, and the Group is responsible for these initiatives. They are also due to monitor the implementation of VPAG. They aren’t mentioned in the July metrics slide deck, nor the operational review meeting minutes.

Future metrics

In the future, sales data will be split by older and newer medicines, according to the meeting minutes. That’s important because, for the first time in a long history of voluntary agreements struck between industry and the UK government, older and new branded medicines are treated differently. Older medicines get a rebate that is based on a base of 10% with adjustments according to price changes that have happened over time.

According to the metrics pack itself, economic growth will also be included in the future.

Those who attended the operational review meeting in July were tasked with reviewing the current metrics paper and flagging areas for improvement with the Department of Health and Social Care. There was also an action for DHSC and ABPI analysts to discuss and agree on further changes to the metrics to deliver alignment with the VPAG objective, plus agreeing on their ownership, production, and timescales.

There will also be metrics developed to track the progress of the VPAG investment fund according to the full VPAG agreement.